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The findings with histologically proven calcific tenosynovitis of the tibialis anterior tendon associated with calcific myonecrosis are described. This case emphasizes the typical appearance of this unusual relationship such as peripheral plaque-like calcifications of the tendon sheath, fluid-calcium levels, presentation as painless mass, and calcification and liquefaction of muscle bundles.
A well-localized nodular mass near on a tendon is often the first clinical sign of a nodular tenosynovitis or so-called tenosynovial giant cell tumor of the tendon sheath. We report three cases of this rare tumor localized at the lower extremity, in correlation with clinical, radiographic and intraoperative findings. After the pathologic diagnosis was made, the patient in the first case decided not to have the tumor resected. This patient's postoperative course continues uneventfully without expansion of the tumor. In the second and third case, a surgical intervation was performed but both developed a local recurrence. A second operation with partial resection of the tendon was successfully performed. To the last follow-up 12 and 24 months after revisions, there were no signs of local recurrence. The review of the literature shows that treatment modalities for such lesions range from excisional biopsy to radiation therapy. The authors present their own experience with the MRI diagnosis and the therapy. Using well-defined histopathologic criteria, marginal resection is the treatment of choice. To prevent a local recurrence, partial resection of the tendon should be done during the primary surgery.
Four groups of specific pathogen-free, day-old chicks were infected experimentally with an avian arthrotropic reovirus strain R2 by four different routes:--oral, subcutaneous, foot-pad and intra-articular. These groups were followed sequentially to study: pathological changes in the hock joints and liver; cloacal virus shedding and the presence of virus in hock joints; serological responses as determined by enzyme linked immunosorbent assay (ELISA), agar gel precipitation (AGP) and virus neutralization tests. All 4 infected groups developed arthritis or tenosynovitis with synovial hyperplasia and lymphocytic infiltration. Foot-pad and intra-articular routes of infection were found to advance the disease process by 2 to 3 weeks after infection by these routes were associated with superficial degenerative changes in articular cartilage. Antibodies were detected at 2 to 3 weeks p.i. by all 3 methods, but there were no significant differences between the patterns of serological response in the infected groups. Injection into the foot-pad appears to be the most convenient and effective parenteral route of experimental infection.
Cytogenetic investigations have already shown the nonrandom involvement of region 1p11-p13 in the localized and diffuse forms of tenosynovial giant cell tumors. We describe a new case of modular tenosynovitis with rearrangement of 16q24. Our findings and the data from the literature strongly indicated band 16q24 as an important new breakpoint for the localized as well as diffuse forms of tenosynovial giant cell tumors.
We report a case of involvement of a finger flexor tendon by sarcoidosis. A review of twelve cases suggests that this is a rare manifestation of the illness that most often affects the finger extensors at the wrist. It tends to present in established sarcoidosis and is associated with a higher than usual incidence of polyarthritis. The main differential diagnosis would be tuberculous tenosynovitis. We suggest that a histological spectrum exists running from a predominantly cellular picture to one of fibrotic nodules, perhaps explaining previously described instances of pseudo-tumour. We would recommend tenosynovectomy in conjunction with corticosteroid therapy as the treatment of choice.
A case of haemangioma arising from the synovial sheath of the flexor tendons of the ring finger is described. The initial symptoms were those of subacute tenosynovitis. The tumour did not affect the flexor tendons and could be completely resected with functional recovery.
Disseminated histoplasmosis is usually a multifocal process with a wide variety of clinical presentations. Despite frequent bone marrow involvement, overt bone and joint disease is uncommon and isolated synovial involvement is extremely rare. We describe in this report an unusual case of disseminated histoplasmosis presenting as acute tenosynovitis. To our knowledge, this is only the second reported case of synovial involvement by H. capsulatum without a concomitant osseous lesion.
We present 2 cases of extensor pollicis longus tenosynovitis caused by the unusual course of the extensor pollicis longus tendon. The extensor pollicis longus tendon passed through the first extensor compartment and was constricted severely. The symptoms were similar to those of de Quervain's disease. The clinical presentation, diagnosis, and surgical technique of this very rare anatomic condition are discussed.
PURPOSE: Dorsal plating of distal radius fractures with titanium plates has resulted in clinically observed tenosynovitis and tendon rupture. The goal of this study was to investigate whether titanium-based implants result in more extensor tendon inflammation than matched stainless-steel implants in a canine fracture model. METHODS: An osteotomy was created in the distal radius of 18 beagles and fixed with 2.7-mm 4-hole plates composed of commercially pure titanium, titanium alloy (Ti-Al6-V4), or 316L stainless steel. Animals were killed at an average of 4 months. Tendon gliding was assessed by applying a force at the extensor musculotendinous junction and noting gliding. Histologic grading (mild, moderate, severe) was based on cellular hypertrophy, hyperplasia, and leukocytic infiltration. RESULTS: Tendons glided freely in 100% stainless-steel specimens, 75% of titanium alloy, and 43% of commercially pure titanium groups. A severe inflammatory reaction was identified in 60% of the titanium alloy (Ti-A16-V4) group, 57% of the pure titanium group, and 0% of the stainless-steel group. CONCLUSIONS: Dorsal plating of the canine radius with commercially pure titanium or titanium alloy implants produced a greater inflammatory peritendinous response than matched stainless-steel implants.
Atypical hand infections with Mycobacterium species are uncommon, and Mycobacterium scrofulaceum infections are rare. We present a case of flexor tenosynovitis caused by M scrofulaceum in a 66-year-old man with hypertension and diabetes.
We report a case of acute carpal tunnel syndrome related to a spontaneous pyogenic tenosynovitis and a review of this clinical condition.
Gonococcal infection of tendon synovial sheath is discussed. A case of acute gonococcal flexor tenosynovitis without joint involvement is presented.
Hand function depends on tendon integrity, but in rheumatoid arthritis tenosynovitis can result in tendon adhesions and rupture. Cytokine inhibitors have proved effective in rheumatoid joint disease; however, their effect on the tenosynovium is not well understood. We investigated the ability of inhibitors of tumour necrosis factor alpha and interleukin 1 to reduce production of collagenolytic matrix metalloproteinases 1 and 13 in tenosynovial tissue obtained from patients with rheumatoid arthritis. Our data show that cytokine blockade can reduce collagenase concentrations in tenosynovial tissue, suggesting cytokine inhibitors could be effective in reduction of tendon damage.
We describe a patient who presented with carpal tunnel syndrome secondary to tuberculous tenosynovitis and who was subsequently shown to have HIV infection. Recognition of this atypical presentation of tuberculosis is important for early, effective treatment.
We report an unusual case of tenosynovitis in the hand. A female farm worker aged 66 developed swelling of the middle and little fingers. Extensive synovectomy of the flexor tendon sheaths was performed, and the synovitis was found to be due to Listeria monocytogenes, which is unusual in this area. Treatment with amoxycillin and gentamicin for 10 days was replaced by trimethoprim-sulfamethoxazole for 3 weeks. There was no recurrence of infection 3 months after surgery, and flexion and extension were complete at that time.
We present five cases of mycobacterial tenosynovitis of the flexor tendons of the fingers. These cases were observed during the last 12 years and treated by the same surgeon. This pathology is uncommon now, but it is becoming more frequent, especially in patients with diminished immunity. The diagnosis was most commonly made after synovectomy in patients presenting with carpal tunnel syndrome associated with slightly painful swelling at the wrist. Histological and bacteriological examinations are very important and revealed tuberculosis in four of our patients and mycobacterium in one, and the treatment consists of synovectomy and appropriate antibiotics. The functional result is usually good, but recurrence is not uncommon. Long-term follow-up is necessary. Local corticosteroid therapy could have a part in the causation of this condition.
We report a case of a flexor sheath tenosynovitis caused by Mycobacterium marinum.
We report a case of a profundus tendon sheath fibroma which initially presented as triggering on wrist movements but rapidly caused a flexor tenosynovitis limiting both finger and wrist movements. Surgical excision was curative.